Bakgrund: Språkbarriär är en av de största hinder inom hälso- och sjukvård och detta kan bero på att patienten inte delar samma språk som vårdpersonalen och därav kan kommunikationen försvåras. Kommunikation är ett av de viktigaste verktygen för sjuksköterskor att kunna ge en god vård till patienter.  Syfte: Syftet med denna litteraturstudie är att belysa sjuksköterskors upplevelse att vårda och kommunicera med patienter med annan språktillhörighet.  Metod: Detta är en litteraturstudie med kvalitativ studiedesign där 11 artiklar granskades.  Databaserna som användes för denna litteraturstudie var PubMed och CinaHL och dataanalysen genomfördes i fem steg Enligt Forsberg och Wengström (2013). Resultat: Det identifierades tre huvudkategorier; Sjuksköterskor upplever språkbarriär; Tolk som redskap; och Utmanande arbete, samt sex relaterade subkategorier. Slutsats: Kommunikation spelar en stor roll för att sjuksköterskor ska kunna ge god omvårdnad. Bristande kommunikationen är ett hinder för att kunna ge säker samt god vård och de flesta sjuksköterskorna upplevde även att det var givande att använda sig utav tolk. / Background: Language barriers are one of the biggest obstacles in healthcare and this may be due to the patient not sharing the same language as the healthcare staff and as a result communication may be difficult. Communication is one of the most important tools for nurses to be able to provide good care to patients. Aim: The aim of this literature study is to illuminate nurses' experience of communication for patients with a different language affiliation. Method: This is a literature study with qualitative design where 11 articles were reviewed. The databases used for this literature study were PubMed and Cinahl and the data analysis was done in five steps according to Forsberg & Wengströms (2013). Results: Three main categories were identified; Nurses experience language barriers; Interpretation as a tool; and Challenging work, and six related subcategories. Conclusion: Communication plays a major role for nurses to provide good nursing care. A lack of communication is an obstacle to being able to provide safe and good care. Most of the nurses also felt that it was rewarding to use an interpreter.

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Background: In the multicultural Sweden, meetings between nurses and patients who do not speak the same language take place daily. Previous research shows that in this type of meeting, challenging situations can arise that can negatively affect the patient's health and create insecurity. Language barriers make it difficult for the patient to participate in their own care because the patients are unable to express their need for care. The use of body language and interpreters can facilitate communication, but difficulties may arise. Aim: To describe nurses' experiences of caring for patients who do not have a common language with the nurses. Method: Qualitative literature study with descriptive synthesis, based on 11 scientific articles. Results: The study resulted in two themes “Challenges in care” and “Strategies in care” where nurses described that well-functioning communication was the basis for safe and secure care and experienced challenges and difficulties when common language with patients was lacking. Nurses used different approaches to communicate with and understand patients' needs for care. Conclusion: Language barriers were considered to be a factor that limited the opportunities for a caring relationship between nurses and patients. Communication difficulties affected the ability of nurses to provide good and safe care, however, language barriers could be eased with the help of strategies and the use of interpreters.

Bakgrund: Med en ökad globalisering uppstår det allt mer språkbarriärer mellan vårdgivare och vårdtagare i vården då det gemensamma språket inte talas. Syfte: Syftet var att beskriva patienters upplevelser av språkbarriärer i vården. Metod: Denna litteraturöversikt är baserad på åtta kvalitativa artiklar som publicerats mellan år 2010-2022 och söktes fram i databaserna Pubmed och Cinahl. Resultaten från artiklarna tematiserades och diskuterades utifrån Joyce Travelbees omvårdnadsteori om mellanmänskliga aspekter. Resultat: Dataanalysen resulterade i tre huvudteman: Kommunikationsproblem vid vårdmöten, Patienters delaktighet i vården och Vikten av professionell vård. Det första temat handlar om problem som uppstår vid vårdmöten på grund av språkbarriärer och bristande tillgång till professionella tolkar. Det andra temat handlar om patienters upplevelser av bristande delaktighet i vården på grund av språkbarriärer medan det tredje handlar om att patienterna beskriver att de vill bli bemötta som en unik individ, de vill bli lyssnade på, bekräftade och vara delaktiga i sin egen vård. Sammanfattning: Språkbarriärer kan leda till en sämre relation mellan vårdpersonal och patient. Att inte använda professionella tolkar i vården kan öka otryggheten för patienterna och på sikt hota patientsäkerheten. Omvårdnad som utgår från Travelbees omvårdnadsteori kan hjälpa sjuksköterskor ska bygga en relation med patienten oavsett språklig och kulturell bakgrund. Att sjuksköterskor verkligen lyssnar och visar förståelse kan skapa en bättre och jämlik vård för alla patienter. / Background: With increasing globalization, there are growing language barriers between healthcare providers and patients in healthcare settings. Aim: To describe patients' experiences of language barriers in healthcare encounters. Method: This literature review is based on eight qualitative articles, published between 2010-2022 and retrieved from the databases Cinahl and PubMed. The results from the articles were thematised and discussed based on Joyce Travelbee’s nursing theory on interpersonal aspects. Results: Data analysis resulted in three main themes: Communication problems in healthcare encounters, Patient participation in healthcare, and the Importance of professional care. The first theme deals with problems that arise during healthcare encounters due to language barriers and a lack of access to professional interpreters. The second theme is about patients' experiences of inadequate participation in healthcare due to language barriers, while the third is about patients' descriptions of wanting to be treated as a unique individual, to be listened to, affirmed, and involved in their own care. Summary: Language barriers can lead to a poorer relationship between healthcare professionals and patients. Not using professional interpreters in healthcare can increase patients' insecurity and ultimately threaten patient safety. Nursing based on Travelbee's nursing theory can help nurses build a relationship with the patient regardless of linguistic and cultural background. Nurses truly listening and showing understanding can create better and more equitable care for all patients.

Introduktion: Ökad migration av människor mellan länder har bidragit till språkliga ochkulturella variationer i samhället. Det ställer högre krav på hälso- och sjukvården och utmanarambulanspersonal i sitt arbete när det saknas ett gemensamt språk. Syfte: Att belysaambulanspersonalens upplevelser när det förekom språkliga barriärer i prehospital vård.Metod: En litteraturöversikt vars resultat baserades på 13 vetenskapliga artiklar; sexkvalitativa, sex kvantitativa och 1 av mixad metod. Analysen genomfördes enligt Whittemoreoch Knafls modell. Resultat: Resultatet presenteras i form av fyra kategorier: upplevdautmaningar i det vårdande mötet, patientsäkerhet och vårdkvalitet, ambulanspersonalenshandläggning och behov av utveckling samt sju subkategorier. Konklusion: Språkliga barriärerinnebar en ökad risk för missförstånd och felbehandling. Ambulanspersonalen hanteradespråkliga barriärer genom anpassningsstrategier för verbal och icke- verbal kommunikation.Informationsbrist och kunskapsbrist påverkade vårdkvalitet och patientsäkerhet. Detidentifierades behov av anpassade hjälpmedel för prehospitalt bruk och utbildningefterfrågades för att nå ökad förståelse vilket kunde underlätta kulturell anpassning ochförbättra ambulanssjukvårdens patientsäkerhet och vårdkvalitet. Det saknades riktlinjer kringspråkbarriärer prehospitalt. / Introduction: Increased migration between countries have increased the presence of culturaland language variations, which enhances demands on the healthcare and on ambulancepersonnel when they are caring with the presence of language barriers. Aim: The purpose ofthis paper was to illuminate ambulance personnel ́s experiences of language barriers inprehospital care. Method: A literature review with results from 13 scientific articles; sixqualitative, six quantitative and one with mixed method. The analysis was based on the methodfrom Whittemore and Knafl. Results: The result is presented in four categories: experiencedchallenges in the caring meeting, patient safety and quality of care, the ambulance personnel ́shandling and need for development as well as seven subcategories. Conclusion: Languagebarriers increased the risk of misunderstanding and maltreatment. Ambulance personnelhandled language barriers through strategies such as adapting to the situation and throughverbal and non-verbal communication. Lack of information and knowledge affected quality ofcare and patient safety. Need for custom aids designed for prehospital settings and educationwas requested to reach increased understanding, which could simplify cultural adaption andimprove prehospital quality of care and patient safety. Guidelines regarding language barrierswere missing.

Bakgrund: Den ökande invandringen i Sverige har bidragit till ökad mångfald i landet med människor som kommer från olika bakgrunder och talar olika språk. Språk är en avgörande faktor för effektiv kommunikation mellan sjuksköterskan och patienten, vilket utgör förutsättningar för personcentrerad vård och delaktighet. I akutvårdsmiljön råder det oftast tidspress och språkbarriärer kan vara ett hinder som påverkar vårdkvalitet. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att vårda patienter i akuta situationer när verbala språkbarriärer föreligger. Metod: En allmän litteraturstudie med induktiv ansats, baserad på 12 vetenskapliga artiklar. Artiklarna hämtades från databaserna PubMed, CINAHL och PsycInfo. Resultat: Efter analys av samtliga artiklar identifierades fyra kategorier utifrån artiklarnas resultat: Erfarenheter av att använda kommunikationsfrämjande metoder, Erfarenheter av språkbarriärers påverkan på vårdkvalitet, Erfarenheter av språkbarriärer som utmaning för sjuksköterskan och Erfarenheter av anpassningar och förändringar i sjuksköterskans roll. Konklusion: I akuta situationer upplevde sjuksköterskor utmaningar med att effektivtkommunicera med patienter när språkbarriärer förekom. Trots dessa utmaningar försökte sjuksköterskorna anpassa sig genom olika kommunikationsmetoder. Stress och tidspress påverkade vårdkvaliteten och patient-sjuksköterska relationen negativt. Det ansågs vara viktigt att anpassa sig till patienternas unika behov för att övervinna språkbarriärer. / Background: The increasing immigration in Sweden has contributed to diversity in the country, with people coming from different backgrounds and speaking different languages. Language is crucial for effective nurse-patient communication that forms the basis for person-centered care and participation. In acute care, there is often time pressure, and language barriers can be an obstacle affecting care quality. Aim: The aim was to describe nurses’ experiences of caring for patients in acute situations when verbal language barriers are present. Method: A general literature review with an inductive approach, based on 12 articles retrieving from PubMed, CINAHL and PsycInfo databases. Results: Four categories were identified from the analysis of the articles’ findings: Experiences of communication-promotion methods, Experiences of language barriers’ impacts on quality of care, Experiences of language barriers as challenges for the nurse and Experiences of adaptations and changes in nursing role. Conclusion: Nurses working in acute situations experienced challenges in communicating effectively with patients when language barriers were present. Despite the challenges, nurses tried to adapt through various communication methods. Stress and time pressure negatively affected the quality of care and the patient-nurse relationship. It was considered important to adapt to every patient’s unique needs to overcome language barriers.

With the vast and continued growth of international students in the U.S., it is important to focus on this expanding group and identify factors that aid or hinder academic performance, achievement, expectations, and competence. Factors known to affect academics among international students, such as language barriers, acculturation to American society, university support and structure, social integration at the university, family support, and motivating factors to study in the U.S were examined. It was hypothesized that these known factors would negatively correlate with the academic outcomes of international students examined in the current study. It was also hypothesized that these factors can combine to best predict the academic outcomes of international college students. First, intercorrelations were conducted with the independent and dependent variables to determine if the factors examined in the study (i.e., language barriers, acculturation to American society, university support and structure, social integration at the university, family support, and motivating factors to study in the U.S.) are negatively correlated with the academic outcomes of international students. Then a series of linear regressions was conducted to test the hypothesis that these factors can combine to best predict the academic outcomes of international college students. Results found significant relationships between the predictor variables and the outcome variables in this study, specifically among support (university, familial, and social), acculturation, language barriers, motivating factors to study, and self-efficacy.

Bakgrund: Sverige idag är ett multi-etniskt och flerspråkigt land där många människor talar ett annat språk än svenska. Språkbarriärer har uppstått som ett resultat av detta, särskilt inom sjukvården. Syfte: Syftet var att belysa sjuksköterskornas erfarenheter vid interkulturell kommunikation med patienter. Metod: Litteraturöversikten innefattade tolv vetenskapliga artiklar med kvalitativ metod och analyserades utifrån Fribergs analysmodell. Analysen genererade två teman och sex subteman. Resultat: Resultaten presenteras utifrån två huvudteman: Utmaningar med språkbarriärer och Kommunikation med tolk. Missförstånd av information på grund av språkbarriären mellan sjuksköterskan och patienten ledde till att patienten undvek kommunikation med sjuksköterskan, vilket skapade ett bristande patientengagemang i deras vård. Tvåspråkiga sjuksköterskor tjänstgjorde emellanåt som tolkar trots deras bristande erfarenhet av att arbeta som tolk. Slutsats: Studien visar att språkliga barriärer gjorde sjuksköterskans arbete och omvårdnadsarbetet samt patientsäker vård mer utmanande. Språkliga barriärer hade en negativ inverkan på både sjuksköterskan och patienten. Med mer kunskap och erfarenhet om interkulturell kommunikation skulle sjuksköterskan kunna medverka till en ökad patientsäkerhet och bättre följsamhet till ordinerad behandling. / Background: Sweden today is a multi-ethnic and multilingual country where many people speak a different language other than swedish. Language barriers have arisen as a result of this, particularly in healthcare. Aim: The purpose was to shed light on the nurses' experiences of intercultural communication with patients. Method: The literature review included twelve scientific articles with a qualitative method and was analyzed based on Friberg's analysis model. The analysis generated two themes and six subthemes. Results: The results are presented based on two main themes: Challenges with language barriers and Communication with an interpreter. Misunderstanding of information due to the language barrier between the nurse and the patient led to patient avoidance of communication with the nurse, creating a lack of patient commitment in their care. Bilingual nurses sometimes served as interpreters despite their lack of experience working as interpreters. Conclusion: The study shows that language barriers made the nurse's work more challenging and, as a result, also made nursing work and patient safety more challenging. The resulting language barriers had a negative impact on both the nurse and the patient. With more knowledge and experience about intercultural communication, the nurse could contribute to increased patient safety and better adherence to prescribed treatment.

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This thesis contributes original knowledge through an inclusive design approach to lowering language and communication barriers in healthcare and suggests shifting the discussion from culture to context to lower intra-cultural hindrances towards learning English amongst some ethnic minorities. It offers an adaptable, scalable concept for gathering data on ethnic minorities (considering both different generations and religions) and employs a framework based analysis in design. Over the course of three studies grounded on theoretical insights from literature, primary research lead to the development and testing of innovative aids for communication, including educative and motivational elements. This research began by seeking to understand ethnic minority consumers (EMCs) perceptions of any barriers hindering their take-up of products or services in the UK, and their preferences. This is particularly significant as the UK s EMC population is predicted to double by 2051 and to diversify further, presenting challenges for social cohesion and planning future community goals. EMCs also represent a significant market for service and product providers. The research focussed on EMCs from the Indian Subcontinent based on religions and generations. It highlighted that first generation females lacking English and/or literacy (across religions and age groups) faced problems with services and issues around empowerment . The importance of improved access to healthcare was a strong theme. On investigating NHS staffs perceptions, five barriers were identified (Language barriers; Low-literacy; a Lack of understanding; Attitudes, gender and health beliefs; and Information retention) and that a female subgroup was particularly affected. This study sets out staffs perceptions of the aids currently employed and suggestions of what would help. It identified a (currently) low use of visual communication aids in adult-patient care and that pharmacist-patient communication in pharmacies was low. Ideally, staff would like patients to learn English and to use more low-cost visual communication aids. These findings lead to the development of innovative visual communication aids through inclusive and user-centred approaches and participatory design and brainstorming methods. This enabled the development of aids by considering the needs of NHS staff, EMCs lacking English and/or literacy and indigenous elderly people to promote better patient-staff communication including a take-away educational element for learning English at home.